The Pulse
12:00 am
Thu September 27, 2012

Mandated flu vaccines?–UPDATE

UPDATE: As of today, October 5, 2012, the Rhode Island Department of Health has issued a ruling that it will mandate flu vaccines for all health care workers and volunteers. You can get a medical exemption with a note from your doctor, or fill out a form saying you refuse to get the shot but understand you’ll have to wear a surgical mask when interacting with patients during flu season. Link to the state regulation (it’s a .pdf).

The Rhode Island chapter of the Service Employees International Union (SEIU), which represents lots of health care workers in the state, is opposing a Department of Health proposal to make the flu vaccine mandatory for health care workers–or make those who refuse wear surgical masks. Why? Here’s what the union says on its web site to members about its position:

[Local] 1199 encourages all health care workers to get the flu vaccine, but we respect the fact that some people choose not to for health, personal, or religious reasons.  Forcing these individuals to wear masks doesn’t make any sense. There’s no scientific evidence that surgical masks help prevent the spread of the flu, and those we care for could feel threatened or uncomfortable if their care givers are wearing masks.

In written testimony for a department hearing on the matter, SEIU explains further:

Based on a number of scientific reviews that have found a lack of statistically significant epidemiological evidence of healthcare worker to patient flu transmission, a relatively low rate of flu vaccine effectiveness compared to other vaccines, unresolved legal and civil rights issues, and ethical considerations including financial conflicts with flu vaccine manufacturers, there is insufficient justification for the RI DOH to adopt a mandatory vaccine or masking policy that will lead to discriminatory and disciplinary action against healthcare workers who refuse to be vaccinated or wear a surgical mask against their will.

So, do the union’s arguments hold up? The answer is…it’s complicated. So I’m turning to some experts, the Centers for Disease Control’s Advisory Committee on Immunization Practices. In their most recent list of recommendations on the topic, the committee comes down on the “better safe than sorry” side of the question, recommending that health care personnel (HCP) be vaccinated every year against flu unless there’s a medical reason they shouldn’t be. But they acknowledge the fact that there’s still uncertainty about the degree to which that recommendation will protect patients. There have been studies showing that vaccinating health care workers reduces sickness and death overall, especially in nursing homes.

However, studies which examine and demonstrate efficacy in preventing more specific outcomes (e.g., laboratory-confirmed influenza illness and mortality) are lacking.

In settings where workers and patients are vaccinated, everyone seems to be better off, the studies say.

As for the vaccine’s efficacy, experts say it really varies from year to year, depending on the actual flu strains included in that year’s mix, but that it’s better to get vaccinated than not. There’s this idea that what helps vaccines work is the herd: the more people get vaccinated, the better protected we all are. So does it take a mandate to increase vaccination rates? Perhaps. When it’s voluntary, CDC research finds that about 63% of health care workers opt for the flu vaccine. Require it, the rate shoots up to 95% (obviously).

The committee’s report provides this reminder, however, of another powerful incentive for hospitals to step up employee flu vaccine programs:

Beginning January 2013, the Centers for Medicaid Services will require acute care hospitals to report HCP influenza vaccine as part of its hospital inpatient quality reporting program.

Do you think health care workers should be required to get an annual flu vaccine? Let me know.

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